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TOPLINE:

A longer diabetes duration and greater daytime hypoglycemia contribute to impaired awareness of hypoglycemia (IAH) in older adults with type 1 diabetes (T1D), with the strongest predictor of restored awareness of hypoglycemia found in those with less daytime hypoglycemia.

METHODOLOGY:

• Previous research has shown that 30% of adults ≥ 60 years have IAH, which is associated with a 6- to 20-fold higher risk for severe hypoglycemia, leading to increased morbidity and mortality in this age group.
• This post hoc analysis of the WISDM study evaluated the clinical and glycemic factors associated with IAH in 199 adults (mean age, 68.1 years; 52% women; 95% White) with a T1D duration of 35.6 years.
• The Clarke score (indicating awareness or reduced awareness of hypoglycemia) classified patients as having IAH (score ≥ 4) or normal awareness of hypoglycemia (NAH) (score < 4).
• The primary objective was to compare the baseline clinical and demographic characteristics and glycemic indices of participants with IAH and NAH.
• Participants with IAH at baseline were also evaluated for hypoglycemic awareness after 26 weeks.

TAKEAWAY:

• Participants with IAH vs NAH had a longer diabetes duration (mean 40.6 vs 33.4 years; P = .003) and were diagnosed with diabetes at a younger age (mean 22 vs 34 years; P < .001).
• Overall, the awareness of hypoglycemia improved in 31% of the participants after 26 weeks in the study.
• A 1% increase in time in daytime hypoglycemia (< 3.0 mmol/L [54 mg/dL]) upped the odds of IAH by 31% (P < .0001) and decreased the odds of restoring hypoglycemia awareness by 45% (P = .029) at 26 weeks.
• A 1-year longer diabetes duration increased the odds of experiencing IAH by 3% (P = .008), while each additional year of diabetes duration decreased the odds of restoring IAH by 4% (P = .07), although the effect size did not reach statistical significance.

IN PRACTICE:

"Less time spent in hypoglycemia < 54 mg/dL is the only modifiable predictor of IAH improvement. Therefore, it should be addressed earlier in the course of disease and managed aggressively, and its importance should be emphasized with patients with long-standing type 1 diabetes," wrote the authors.

SOURCE:

The study, led by Anika Bilal, MD, Translational Research Institute, AdventHealth, Orlando, Florida, was published online in Diabetes Care.

LIMITATIONS:

The study population lacked diversity in the racial, ethnic, and socioeconomic backgrounds. Moreover, only a limited number of individuals with health disparities, cognitive dysfunction, and frailty were included, which may limit the generalizability of the findings. The use of the Clarke score for measuring IAH may have some limitations among those using continuous glucose monitoring. The 26-week study may not have been long enough to detect improvements in hypoglycemia awareness from use of nonblinded continuous glucose monitoring in one group.

DISCLOSURES:

The WISDM study was funded by the JDRF, Leona M. and Harry B. Helmsley Charitable Trust, National Center for Research Resources, and National Center for Advancing Translational Sciences of the National Institutes of Health. One of the authors declared receiving consulting and speaker fees and grants from multiple pharmaceutical and medical device companies.